Summary & Overview
CPT 23075: Excision of Subcutaneous Shoulder Mass, Specimen < 3 cm
CPT code 23075 denotes surgical excision of an abnormal skin or subcutaneous mass in the shoulder region with the specimen under 3 cm submitted for pathological analysis. This code is used to classify a common minor surgical procedure that has implications for coding accuracy, surgical documentation, and claims processing across outpatient and ambulatory surgical settings. Nationally, proper use of this code affects reimbursement, quality reporting, and downstream pathology and follow-up care workflows.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings for CPT code 23075, typical billing considerations, and the benchmarks and policy topics that commonly influence coverage and claims adjudication for minor soft-tissue excisions. The publication summarizes coding applications, typical sites of service, and the administrative elements that providers and coding professionals should confirm in medical records and operative reports.
The content is intended to inform billing staff, surgical teams, and policy analysts about how CPT code 23075 is used, where it applies clinically, and what areas (documentation, pathology submission, and site-of-service designation) frequently determine correct coding and payment outcomes. Data not available in the input includes payer-specific reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings.
Billing Code Overview
CPT code 23075 describes the excision of an abnormal mass or tumor located within the subcutaneous tissue of the shoulder. The procedure includes removal of the lesion and submission of the specimen, measuring less than 3 cm including margins, to a laboratory for analysis and diagnosis.
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Service type: Surgical excision of subcutaneous shoulder mass
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Typical site of service: Outpatient surgical suite or ambulatory surgery center; may also be performed in a hospital operating room depending on clinical circumstances.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an outpatient ambulatory surgery center with a palpable, enlarging, tender 2.2 cm subcutaneous mass on the lateral aspect of the right shoulder. Physical exam findings and prior ultrasound suggest a likely epidermal inclusion cyst versus lipoma. The patient is evaluated preoperatively by the surgeon, consents for excision with submission of the specimen for pathology, and is scheduled for a minor procedure under local anesthesia with monitored sedation available. Intraoperative workflow includes marking the lesion, local infiltration with anesthetic, elliptical incision, dissection and excision of the mass with intact capsule, hemostasis, irrigation, layered closure, and dressing application. The specimen, measuring less than 3.0 cm including margins, is placed in formalin and sent to the pathology laboratory with a requisition for histologic diagnosis. Postoperative instructions are provided and a follow-up visit is arranged for wound check and pathology review. Typical site of service is an ambulatory surgery center or office-based procedure room. Service type: minor surgical excision of a subcutaneous shoulder mass with pathology submission, corresponding to 23075.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician professional portion of a split-billed service (rare for excision procedures with global surgical filing). |